They are legal, are drugs less harmful?

Currently, substance abuse is one of the main public health problems and a major global problem.

There are many types of drugs that can be categorized in different ways and one type of classification would be illegal vs. legal, which would include:

– Illegal: Cannabis, stimulants (cocaine, methamphetamine, amphetamine, methylphenidate…), hallucinogens (LSD), phencyclidine, opiates, inhalants, ketamine…

– Legal: Benzodiazepines and other sedative-hypnotics, alcohol and tobacco.

On a social level it seems that legal drugs are less harmful, not only because they are allowed, but also because they are associated with moments of both celebration and discomfort, allowing their use to be accepted by others in multiple environments, which facilitates abuse and the consequences derived from it.

But… legal drugs are not so harmful?

Benzodiazepines and other sedative-hypnotics

They are a pharmacological treatment used for insomnia and anxiety, but there are people who use them as a recreational form. Chronic consumption of benzodiazepines, such as sedatives-hypnotics at doses higher than therapeutic doses, causes physical dependence and withdrawal symptoms that can be serious and pose a threat to life.


– Physical effects: In not too intense poisoning the subject experiences dry mouth, apathy, decreased muscle tone, incoordination, impaired consciousness in the form of obnubilation and drowsiness. If the consumption progresses, the signs become more intense, being able to reach coma and respiratory depression.

– Psychological effects: In the poisoning by benzodiazepines usually appear memory problems, decreased judgment, coordination problems and speech among other cognitive and motor symptoms.

At the behavioral level it can be associated with behavioral disinhibition, which in some people can lead to hostile or aggressive behavior; This effect is perhaps more frequent when ingested mixed with alcohol. Intoxication with these drugs is similar to alcohol intoxication and the desired effect is a state of disinhibition, elevation of mood, with reduced self-criticism, anxiety and guilt. But the mood can quickly move from euphoria to dysphoria and consumers may be irritable, hypochondriacal, anxious and agitated.


Withdrawal symptoms include intolerance to bright light and loud noises, sweating, nausea, vomiting and decreased appetite, muscle contractures, tremors that can lead to seizures. In relation to emotional consequences, emotional distress, dysphoria and anxiety may appear. The sleep-wake cycle can be seriously altered, generating insomnia and nightmares, since a consequence that is found after the excessive consumption of these drugs are the rebound symptoms, which consists in the symptoms for which the drug was prescribed, for example anxiety or insomnia, they come back after a few days or weeks after stopping consumption.


According to the World Health Organization, “there may be damage from alcohol intake if 20g of ethanol is consumed daily”; This amount amounts to approximately three glasses of wine daily. Continued consumption, even if it is small and produces problems, can be considered risk consumption. The risk is not only related to a high amount of consumption, but also to the way in which it is carried out, moderate and continuous consumption, or excessive punctual consumption, are dangerous both for the risk of alcoholism development and for the consequences of acute poisoning that lead to ethyl coma, violent acts, accidents with physical injuries and problems in interpersonal relationships.


– With moderate consumption: the effects are sedation, slow thinking, disinhibition, mild clumsiness and difficulty in pronunciation, euphoria or mild irritability that can lead to alterations in behavior with possible episodes of aggressiveness, impulsivity and loss of control.

– With high consumption: Obnubilation of consciousness appears with generalized deterioration of all cognitive functions, such as judgment, memory and attention. Important difficulty in walking and speaking. Dysphoria and behavior disorders, which is accompanied by significant hostility and aggressiveness.

– Very high consumption: It can generate stupor with progressive decrease of the response to stimuli until its absence and coma. High risk of bronchoaspiration and respiratory compromise. Social and family conflicts, with labor and legal difficulties.

– There is an alcohol-induced disorder called pathological poisoning and is one that occurs with small amounts of alcohol that normally do not produce any symptoms, but that in predisposed individuals cause serious alterations in behavior and aggressiveness, sometimes accompanied by hallucinations. They usually end up with spontaneous or induced sleep and are considered a negative reaction to alcohol.


After cessation or reduction of excessive alcohol intake, sweating, elevated blood pressure, tachycardia, hand tremor, insomnia, anxiety, nausea or vomiting, transient visual, tactile or auditory hallucinations and agitation may occur. These symptoms can lead to seizures, impaired consciousness, difficulty in maintaining attention, disorientation and may justify immediate hospitalization. Alcohol withdrawal is one of the most serious of all drugs and can lead to death.


The relationship between smoking and the onset of serious illnesses is becoming clearer, which has led to an increase in demands in the healthcare community. In recent years, social disapproval and legal sanctions have favored the reduction of tobacco consumption.


The effect of tobacco on mortality from chronic disease is very large:

– A smoker is ten times more likely to suffer from lung cancer than a non-smoker and in heavy smokers (two packages or more) is 15 to 25 times higher.

– Tobacco accounts for 90 percent of the development of chronic bronchitis and emphysema.

– Smokers are at risk of dying from coronary heart disease two to four times more.

– The habit of smoking negatively influences fertility, in women it is comparable to being ten years older in relation to the quality of the ovules; in men it causes alterations in the levels of hormones that affect the quality and quantity of sperm.

– Children of smoking mothers weigh less at birth, increases the risk of delivery of dead fetus and neonatal death, probably due to the absorption of lead, cadmium and cyanide from smoke.

– As immediate symptoms, morning cough appears, deficiency in breathing, fatigue, sputum production, hoarseness, increased pulse, spots on the skin and teeth, increased frequency, duration and severity of colds.


Sometimes smokers consider that the damage is already caused and it makes no sense to quit smoking, but in reality it is not so: quitting smoking causes immediate and long-term benefits. Life expectancy is longer in patients who quit consumption after a diagnosis of illness, than in those who continue to smoke. The risk of heart disease attributable to tobacco in the first year of withdrawal is reduced by 50 percent and the following year reaches the level of people who have never smoked.

Psychology Service

California University Hospital

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